Etomidate in Canadian EDs

Letters

CJEM 2001;3(3):176-177

To the editor:
Etomidate is widely used in US emergency departments (EDs) as an induction agent for rapid sequence intubation (RSI); however, it is unavailable in Canada except by special release from the Health Protection Branch. Recently, our two Montreal area EDs have pooled preliminary data documenting etomidate use for RSI.

Using an induction dose of 0.3 mg/kg, with 1.5 mg/kg of succinylcholine, we have obtained very good results. In 25 cases, the mean changes in systolic and diastolic blood pressure were (-) 0.2 mm Hg and (+) 6.1 mm Hg respectively (these values refer to the maximal differences seen within 15 minutes of induction). Mean change in heart rate was (+) 4.2 beats/min, and in oxygen saturation, (+) 0.7%. Sedation and muscle relaxation were adequate, intubations were achieved without complication, and no adverse effects were recorded (muscular activity, seizures, dysrhythmias, bronchospasm, nausea or vomiting, pain on injection, thrombophlebitis, infections or clinical multiple organ dysfunction/adrenal insufficiency).

These results are in keeping with other published data on etomidate use for ED RSI.1-4 Etomidate provides good intubation conditions and some neuroprotective effects with a low incidence of adverse hemodynamic effects. Of the induction agents on the market, it seems to offer "the best balance of utility and safety."5 We encourage Canadian emergency physicians to expand their experience with this agent for optimal results in most ED intubations. Those interested in applying for etomidate use or in contributing to our prospective registry are invited to contact the authors.

J.E. Chirgwin, MD
Emergency Department
St. Mary's Hospital Center
Montreal, Que.
mdcn@total.net
C. Croteau, MD
Departement d'urgence
Centre Hospitalier du Sacre-Coeur
Montreal, Que.
christian.croteau@sympatico.ca

References

1. Schenarts CL, Burton JH, Riker R. Adrenocortical dysfunction following etomidate induction in emergency department patients. Acad Emerg Med 2001;8:1-7.
2. Sokolove PE, Price DD, Okada P. The Safety of etomidate for emergency rapid sequence intubation of pediatric patients. Pediatr Emerg Care 2000;16(1):18-21.
3. Smith DC, Bergen JM, Smithline H, Kirschner R. A trial of etomidate for rapid sequence intubation in the emergency department. J Emerg Med 2000;18(1):13-6.
4. Plewa MC, King R, Johnson D, Adams D, Engoren M. Etomidate use during emergency intubation of trauma patients. Am J Emerg Med 1997;15(1):98-100.
5. Schneider RE. Sedatives and induction agents. In: Walls RM, et al, editors. Manual of emergency airway management. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 132.